It took AIDS activists 21 years to get Congress to restore federal funding for local programs that supply clean needles to drug users. It's taken Republicans a couple of months of hardball negotiations to get the ban reinstated.

Legislation to fund government operations for 2012, which President Obama is about to sign, includes an amendment prohibiting federal spending on needle exchanges in both domestic and international programs. That was the law from 1988 until December 2009, when Obama signed a Democratic-sponsored appropriations bill lifting the restrictions.

The ban will have no immediate impact in San Francisco, where the AIDS Foundation leads a group of contractors that use city funds and private donations to hand out about 2.5 million sterile needles per year. But backers of the programs say it's a big step backward for public health.

"Reinstating the ban is murderous. It's saying that people who use drugs should contract fatal and expensive diseases and die," said Laura Thomas, San Francisco director of the Drug Policy Alliance and a volunteer in a local needle-exchange program for the last 15 years.

The city, which spent $1.2 million on needle exchanges last year, decided not to apply for federal funds when they became available in 2010 because they didn't appear to be a stable revenue source in light of "the volatile economic and political climate," said Israel Nieves-Rivera, a program director at the Department of Public Health.

Preventing expansion

But he said the absence of federal support, and the elimination of state AIDS funding in 2009, will prevent counties from expanding their needle-exchange programs to reach everyone in need.

That's the case in Marin County, where the Marin AIDS Project uses $16,000 in private contributions to distribute 65,000 needles a year at its San Rafael office.

Director Jennifer Malone said the project has received a $28,500 grant from the federal Centers for Disease Control for 2012 and was planning to use it to resume needle exchanges for high-risk populations in West and South Marin and Novato. Those exchanges ended when the state cut off AIDS funding.

She said the federal restrictions mean the money can be used only for AIDS education and testing and not needle distribution. Although a new California law will allow drug users to buy up to 30 needles at a time at a pharmacy without a prescription, Malone said they're much more likely to obtain clean syringes in the free programs.

"Exchanges are anonymous, which feels more accessible to people, and you can exchange much larger numbers of syringes," she said, observing that individuals often pick up needles for multiple users. "I hope there's some change at the federal level."

Infection rates cut

Researchers have found that sharing of contaminated needles by drug users is a major source of infectious diseases like AIDS and hepatitis C, which are reduced by the distribution of clean syringes.

A 1997 study said HIV infection rates had dropped by 5.8 percent in 29 cities around the world with needle-exchange programs, and increased by 5.9 percent in 52 cities without them. A report in 2000 by David Satcher, surgeon general under President George H.W. Bush, said the programs reduce HIV transmission among vulnerable populations without increasing drug use.

Opponents argue, however, that needle exchanges encourage the use of dangerous drugs and that federal funding undercuts the government's antidrug message.

The funding ban was sponsored in 1988 by the late Sen. Jesse Helms, R-N.C., and renewed annually for 21 years. It was removed in 2009 in a close vote that largely followed party lines, but House Republicans used the issue as a bargaining chip this year on a $1 trillion bill that had to be passed to avert a government shutdown.

Republican leaders initially demanded wholesale concessions from Obama as the price of approval, including elimination of funding for the new federal health care and bank-regulation laws and a ban on federal regulation of greenhouse gases.

They settled Dec. 15 for a more modest agreement that included a continued ban on federal and local funding for poor women's abortions in Washington, D.C., and a renewal of the prohibition on federal spending for needle exchanges.

The legislation was "the product of a tough negotiation," said White House spokesman Adam Abrams. "To reach a compromise, we had to accept certain provisions that we oppose and these are two of them."

That didn't satisfy advocates like Bill Piper of the Drug Policy Alliance. Thousands of preventable diseases, he said, will be the responsibility of "the Republicans who insisted on restoring the ban, and the Democrats who didn't fight hard enough to oppose it."

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